House - Episode 3 (Season 4): “97 Seconds”
Another episode of House that focuses more on the applicants (or hirelings, if you prefer) and soap opera rather than the medicine. That’s not necessarily a bad thing, and it was an enjoyable episode soap opera wise. I just wish it had better medicine. Spoilers below!
The main patient tonight is Stark, a 37 y/o man with Spinal Muscular Atrophy, an incurable and progressive neurological disease that weakens muscles. He is wheelchair bound and assisted by his dog Hoover. While crossing the street, Stark faints without warning and is nearly hit by a car. He is admitted to the hospital to find out why he had the fainting spell.
House divides the ten remaining applicants into two teams of five each: boys versus girls. The team that diagnoses Stark correctly wins and gets to remain. The losing team is fired. Everybody’s favorite alpha-female Amber wants to join the men’s team but they rebuff her.
Both teams initially consider that Stark may have picked up a bacterial infection from his dog Hoover, but discard the idea. The women’s team now decides that he must have become infected with Strongyloides (threadworm) on his recent trip to Thailand. They treat him with Ivermectin, an antihelminthic drug (i.e. an anti-worm drug). The men have no working diagnosis and want to run a full battery of tests on Stark’s hair, blood, and stool. During this conversation, it is revealed that Stark is also incredibly constipated. Amber manages to finagle her way onto the men’s team by convincing them to try xenodiagnosis — basically, have a bug bite the patient, and test the bug for any parasites that the patient may have (of course, this would only test for blood-borne parasites, not ones in the intestines or other organs). In the middle of the test, Stark starts choking and coughing.
The next morning, House reveals that the patient has suffered an aspiration, but is improving on oxygen and chest PT (though the patient is shown receiving a nebulizer. Aspiration pneumonia, a nasty type of pneumonia, would be a concern in this patient). House seems intrigued by the women’s diagnosis of Strongyloides and dismayed that the men have only managed to run test after test. He places the men’s team in the “penalty box” — making them sit in his office and not talk about the case while the women go about proving theirs. Their plan is to perform a tilt table test on Stark and try to induce a fainting spell. If the test is negative and there is no fainting, then their diagnosis and treatment must be right (but not necessarily, the tilt table test only reproduces certain types of syncope — and not the type the patient has — and/or he might be getting better for other reasons beside their treatment).
Amber and the guys have not given up. They want to know whether Stark’s choking is dysphagia (difficulty swallowing) or achalasia (an esophageal motility disorder). The old guy suggests paraganglioma — a tumor in the neck that presses against the vagal nerve, thus causing fainting, whenever the patient eats. The tilt table test is negative, seeming to confirm the women’s diagnosis and treatment, but Amber runs a CT on Stark anyway. No tumor is revealed, but she believes the results are consistent with scleroderma, a type of connective tissue disease that commonly affects the skin and esophagus. House disagrees and fires the men and Amber. She’s not done though, she talks Chase into running labs on the patient for her. She wants to run an anti-centromere antibody test, a blood test that is sensitive for scleroderma. When she draws the patient’s blood, it turns out to be green.
With this finding, House “rehires” the men’s team and Amber because the diagnosis he thought was right clearly is not. The plastic surgeon deduces that the blood is green because the contrast for the CT the patient had the day before has not been filtered out by the kidneys meaning that Stark has kidney failure. (Who runs a contrast CT on a hospitalized patient without checking kidney function first? That’s very sloppy medicine by Amber, even if she did run the test herself).
The differential is now a gram negative bacterial infection from his indwelling catheter versus scleroderma. House orders Stark to be started on Ampicillin and Gentamicin, two potent antibiotics, for the possible infection; he also orders skin and lymph node biopsies to look for scleroderma. Shortly, the team reveal that the antibiotics are having no effect (though it seems mighty quick to make that judgment) and the biopsies are negative. Or are they? House notices some black specks in the cervical lymph node biopsy and suspects that Stark has melanoma of the eye that has spread throughout the body He wants to remove the eye and manages to talk Cuddy into agreeing with the surgery. Before surgery, the applicants are performing a thoracentesis (draining the fluid from around Stark’s lungs) to make his breathing easier when they notice the fluid is clear. This is not consistent with fluid from a cancer, which tends to be cloudy and bloody. Stepping in after House’s injury (discussed below), Wilson and the team decide that Stark has Eosinophilic Pneumonia, and he is started on corticosteroids and cyclophosphamide (a potent immune suppressant and chemotherapy drug, that has been used for certain types Eosinophilc Pneumonia). The medication doesn’t help and Stark dies quickly and quietly, his faithful dog by his side. When the dog is revealed to be dead a few minutes later, House realizes that Hoover took the patient’s Invermectin (which is fatal to that breed of dog) instead of the patient. Thus, the women were right and the patient had Strongyloides all along, and died of an overwhelming threadworm infection.
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While the team is treating Stark, House sees a patient in clinic who pulls out a knife and sticks it in the wall socket right in front of him. House manages to revive him and the patient admits that he was in a car accident a few days previous and experienced a near death experience. He reports that it was the happiest that he’s ever been and wants to replicate the experience. Later, when Wilson accuses House of not knowing for sure whether there is an afterlife or not, House decides to find out for himself, and sticks the patient’s knife in a wall socket (but not before paging Amber). She performs CPR and manages to revive him, though he suffered a burned hand and an extended loss of consciousness. Because of this, Wilson had to take over Stark’s case in the end. |
| Meanwhile, at a hospital across town, Foreman is running his own diagnostic team, only he is trying to make it friendlier and more supportive than House’s. They have a patient with fever, boggy lungs, and blurry vision who the antibiotics aren’t helping. The team diagnoses Apergillosis and starts the patient on Amphotericin B. It doesn’t help, and the patient now develops yellow gums, a sign of jaundice. Foreman believes that the patient has anaplastic large cell lymphoma, a rare and aggressive cancer. He wants to start treatment right away. His boss disagrees and feels that a severe infection is most likely. He has Foreman start a potent antibiotic. Foreman’s gut feeling gets the best of him and he stops the antibiotic and starts the cancer therapy. He is correct and saves the patient life, but his boss fires him for not following the guidelines and putting his gut feelings ahead of medicine. |
Medically, the episode was rather limited — which is to be expected in a story with six patients and more than a dozen doctors. The ultimate solution was interesting and not expected. I’m not sure exactly how the Strongyloides led to fainting, unless it was a severe case of disseminated Strongyloides, and even then it’s a stretch. The women never confirmed, or even tested for, the diagnosis of Strongyloides. Stool samples are the most common test, but it can take up to seven, but there is a good blood test for the infection. Most experts recommend at least two doses of Ivermectin, if not more. The disease progressed remarkably rapidly, but then Stark was in a debilitated condition, and given immunosuppressants, which are a bad idea with disseminated Strongyloides. It’s not generally the physician’s responsibility to make sure the patient takes the medication (I’m not sure whose it is — at some point, you just have to assume the patient wants to get better and trust that he will take the medication). I’m also unclear why the dog ended up with medication. Did he eat it of his own accord (his name “Hoover” suggests this may be a possibility), or did Stark feed it to the dog? If it’s the former, why wouldn’t Stark tell someone that he didn’t get his medication?
Just because a tilt table test was negative does not prove the diagnosis of Strongyloides. Tilt tables are best for certain kinds of fainting — for instance, orthostatic hypotension that occurs when people stand up suddenly. When was the last time Stark stood up? It’s a poor choice of tests to begin with, and did they have a positive test before treatment to compare it to? It’s basically a post hoc ergo propter hoc error.
Finally, where did House get the idea that the suspected cancer cells must come from the eye because the eye is the only thing that drains to that lymph node? Lymph node drainage is a lot more complex than that. An eye may indeed drain to one lymph node, but it is not the only part of the body that drains there.
As for the clinic patient — I am not an electrician — but wouldn’t you need to complete the circuit, that is have metal in both parts of the socket, for the electricity to flow (assuming the hospital is grounded correctly)?
I give the medical mystery a C, as it was vague and not particularly unusual (fainting?). The final solution I give a B- because it was unexpected but should have been diagnosed and treated better. The medicine was uninspiring, and either team came close to convincing of their cases (and nor did House); it earns a C-. Once again, the soap opera was the best part, though — with the exception of Amber and Dr. 13 — the female characters were bland. Seeing Cameron and Chase was good (Cameron was easily manipulated, but Chase caught on — but still went for it), though I would have liked to see more depth in the Foreman scenes. Still, I give the soap opera an A.
The previous House review
A list of all prior House reviews
Tomorrow night I’ll be taking a look at the new ABC show Private Practice (Last week’s review can be found here)
October 10th, 2007 at 12:07 am
I’m still really unclear how a patient with all of his mental faculties would not mention that he had not been able to take his medication unless he really didn’t want to take it (in fact, when they got to that bit, I thought he’d be the third in the life-after-death theme). I can’t see how it’s 13’s fault (or how it took the dog that long to die, since I’m assuming he ate the pills soon after they were given to Stark).
October 10th, 2007 at 12:26 am
I like seeing the old young guns in other roles more like Wilson, I hope they don’t do a reset button and end up with those 3 back under House and the new guys out the door.
October 10th, 2007 at 12:34 am
Here’s the best guess on what happened with that medication.
When #13 was going to get the patient his water, the men showed up and started collecting their samples, including pushing away his tray so they could pick him up and take him to the bathroom for a stool sample. In the confusion/clumsiness of six doctors working on one guy, the cup and pills were knocked onto the floor. The patient either forgot he didn’t take the medicine or thought it wasn’t necessary anymore (since they were now convinced that something else was wrong with him…even if House told him about the “game” beforehand, this is a lot of doctoring to keep straight without a scorecard), and didn’t bring it up later.
October 10th, 2007 at 12:37 am
As for the electric stuff, people do get hurt putting metal and/or fingers in just one slot of a socket, so I guess that means the circuit gets completed some other way.
October 10th, 2007 at 12:40 am
With the electrical socket House and the subplot patient would not have to complete the circuit from one hole to the other top one to get a serious shock, but without either crossing the hot wire to the ground pole or to a potential grounding source in the average person there would not be enough current flowing through the body to stop the heart. In fact just shoving a knife into a socket like that the electricity wouldn’t even cross the heart.
Also you nailed it with the immuno-suppressants and the weakened condition causing the disseminated Strongyloides. The only thing you missed was the timing factor. It probably did not progress as rapidly as his fainting was probably originally caused by the fluid buildup in his lungs.
I don’t believe he fed the dog the pills. The show seems to imply that while Kumar and the other guy brought him to attempt to give a stool sample the dog jumped up and ate the pills. He would probably have dumped them out of the cup. The cup itself was chewed up as well as hidden under the drawers, which was out of Stark’s reach.
What’s with the show and not exactly understanding the tilt table test? I seem to remember them messing it up in an old episode.
October 10th, 2007 at 12:40 am
Cameron Chase? Doctor 13? Is this a DC comics review, or a House review? I’m confused now!
October 10th, 2007 at 12:53 am
Nope, you only need a connection from the negative terminal to ground - his foot completed the connection well enough. It’s the same reason why its so dangerous to stick a single pin into a live electrical socket.
October 10th, 2007 at 1:00 am
Speaking from experience, no, you do not need to stick metal objects in both holes of an electrical outlet to get zapped. Before anyone pokes fun, let me state that I was a very curious three-year-old when I found that out.
One thing I wanted to clear up: I understand the purpose of a contrast material, but I was led to believe that the slight radioactivity of the material is what made it useful in scans. Would it actually dye your blood a different color? That seems hard to believe.
October 10th, 2007 at 1:07 am
Upon reflection, I like how they threw in some mundane “follow the clues” mysteries in this episode and in the first one. Neither of those required any in-depth medical knowledge to solve, just an analytical mind and some attention to detail. Not that I want every episode from now on to be a case of find-the-screwup instead of make-the-diagnosis, but these things do happen in real life.
October 10th, 2007 at 1:07 am
This episode bugged the hell out of me. Too many logic trains are running around (the woman vet stating that it’d be unfair to the men’s team if the disease involved the dog, too many sentences that begin with “The only reason you’d do that …”, etc.)
House’ electrocuting himself was insane. Firstly, House would never doubt his understanding and buy the near-death experience claims of the patient. Secondly, he should have been fired for it (yes, this is not the first time House conducted an experiment on himself and jeopardized patient care, but this was guaranteed to knock him out).
So, Foreman is fired. What now? If he gets re-hired, I will be upset.
October 10th, 2007 at 1:23 am
I’d have to say the electrical scenes were rather over-dramatized. The voltage in a normal outlet is too low to cause much in the way of arcing or burns to human flesh in the manner shown. It’s also improbable that you would get a lethal shock that way in a normal dry room; typically you would need to be touching some grounded metal object with the other hand or be on damp ground for enough current to flow. On the other hand, unlikely doesn’t mean impossible, so never take the risk!
October 10th, 2007 at 1:24 am
I’m willing to accept House’s melanoma in the eye diagnosis as one of those times he goes for the really crazy idea for what seems to be the hell of it, which is probably bad medicine but relatively consistent with his character on the show.
The socket thing: first off, at least they did poke it into the correct hole (the live is on the left: had they poked the knife into the right (neutral) it would’ve done nothing!), so at least they didn’t mess up that badly. For the current to pass through the body without involving the neutral, the body must be grounded at another point away from the arm, which is pretty unlikely given that House was wearing rubber-soled shoes and pants on carpet on (I assume) the second floor of the hospital.
A lot of sloppiness still on the writing, which seems to coincide with the general chaos of so many doctors running around, but I’m glad to see they’ve managed to get at least one of the characters to develop a bit.
I still like the old fraud though.
Honestly, I feel a bit of schadenfreude from Foreman’s firing because I’m sick of him trying to be holier-than-House.
October 10th, 2007 at 1:25 am
Agreed with Ian, as a rather too curious 6 year old, I touched an exposed fuse. While I’m certain to never repeat that mistake, my hand was/is fine.
October 10th, 2007 at 1:25 am
To address some of the issues here:
1. you can electrocute yourself without completing the circuit, assuming the socket has somewhat lousy breakers. One of the two plugs is actually ‘live’, the other is simply ground. However, the actual floor, a radiator, and various other surfaces are also ‘ground’. If you are in contact with ground while you touch the live wire, you electrocute yourself. Breakers measure the difference between ground and live and will ‘pop’ (those thingies with a test button on them do exactly that right at the socket), but on big circuits it can take a while.
2. The guy didn’t take his medicine because he was pretty much done with becoming even more debilitated. A bit odd, because as I understood it, his chances of recovering to the state he was in before the fainting were good, but perhaps this wasn’t properly explained. He dropped the medicine behind the bedside cabinet so no one would notice, and the dog ate it. Biggest hole here is that dogs with that kind of training don’t normally eat random crap with no interesting smell from behind a cabinet floor like that.
3. The constipation thing seems unrelated to any of this. Was it ever explained? Is it a common side-effect of any of the treatments, tests, the SMA, or the strongyloides? It would explain why it was somewhat difficult to confirm the worms. In real life there are better ways to confirm strongyloides, but in the house view of diagnostic medicine, once you have an idea and the cure isn’t too complicated, give the cure, and if that doesn’t work, that wasn’t it. That part of House is mostly a given so I wouldn’t fault it entirely on bad medicine on the part of the writers.
October 10th, 2007 at 1:27 am
I should note that the North American 110V is small potatoes and unlikely to fry tissue that badly.
I’ve shocked myself on the European 230V and that didn’t burn me, although it was quite a bit more powerful and definitely could’ve ended badly.
October 10th, 2007 at 1:28 am
I actually found myself wishing this episode were longer, if only to more fully develop some of the plot threads in what was an admittedly packed script.
The heart-to-heart between House and the clinic patient seemed too abrupt to whet House’s curiosity about whether there is an “other side.” And, considering House already had a near-death experience in “Three Stories” that left him totally unconvinced about the existence of an afterlife, I’m hard-pressed to see why he’d pull a “Flatliners” this time.
The scenes of Foreman (in New York City, not on the other side of Plainsboro, NJ) seemed to skip by too quickly to have much resonance, especially since we were never introduced to his patient.
And what was that Dr. Not-Cuddy said to Foreman just before she fired him? “You confused saving the patient with doing the right thing”? Huh? (Brings to mind that old cliché, “The operation was a success, but the patient died anyway.”)
But I guess the whole ep was worth it for the moment when Wilson tells House he’s upping his pain medication, and House tells him: “I love you.”
October 10th, 2007 at 1:30 am
I’m no electrician, but isn’t it the amperage that causes the real damage, more than the voltage?
October 10th, 2007 at 1:33 am
I’m pretty sure the patient didn’t take his pills on purpose. Or at least, that’s we’re supposed to think. He was depressed with his life, as evidenced by his refusal to have his eye removed. I didn’t get the tilt-table test though. I thought the women’s logic was that if he didn’t faint, that means the pills cured him, ergo he had the worms. Otherwise, wouldn’t they have done the tilt-table test before giving him the pills?
I thought one of the patient’s problems was inability to go to the bathroom–that’s why Amber and the guys were going to use bugs. That would explain why the women didn’t test for the worms in his stool.
Assuming the green blood is caused by the contrast, realistically how green could it possibly be? Obviously they over did the color change for the show, but would it actually turn blatantly green, or would it just be a slight tinting?
Finally, 13’s big problem wasn’t not forcing the patient to take the pills, but not telling House she didn’t, especially after he died and he asked her directly. I’m actually surprised the character survived to the next round.
October 10th, 2007 at 1:36 am
The patient appears to have chosen to die, which is why he didn’t tell anyone he wasn’t taking his medication.
October 10th, 2007 at 1:40 am
Scott, I was interested in what you thought of the very quick situation that was presented to Foreman. Were there other medical options to lend further support to his diagnosis? Or was he just wrong to take the risk?
October 10th, 2007 at 1:40 am
Adding to the “here are my personal experiences with zapping myself”, when I was three or four I stuck my (I think *wet*, even) finger in the outlet above the bathroom sink. I remember an intense sensation of vibration and a lot of buzzing in my head, to the point of some pain, but no damage done. (That was also the year I put a bead up my nose and got it stuck. Twice. I’m not sure if that was before or after the do-it-yourself ECT.) Anyway, it seems unlikely that House would have been that badly damaged.
October 10th, 2007 at 1:57 am
It’s my understanding that Stark wanted the dog to die with him and that’s why he gave him the pills, but yeah, the amount of time that passed between getting the pills and the dog dying is not explained!! Also would have required a bit of knowledge on his part to know that those exact pills would be fatal for that exact breed, not something I would expect the average dog owner to know.
The writers are cramming so much stuff into each episode at this point that they have to skip over details that make the plot flow together. We don’t even know the names of some of the new docs! What’s the secret here with those? Even House had to ask 13 what her name was and she didn’t respond.
I would guess that the nurse that distributes meds on the rounds would check that the patient takes them, but hey, we haven’t even seen any nurses in like a dozen episodes now so there’s no point in trying to figure that one out. Oh wait, there were two nurses who brought in the crash cart when the clinic patient zapped himself. Guess that counts. :-)
Now as for House zapping himself, uhhh, yeah… If anybody else had done that it would have been straight to the psych ward, or at least suicide watch and restraints. He did not (want to?) send the clinic patient to psych and I don’t really know why. One of those details that were skipped over in the race to complete a handful of plot lines in one show. As for the rest, more House vs. God stuff which will probably make some fans happy, but totally underdeveloped.
It seems like they desperately needed to fit in a Foreman cameo to match the Chase/Cameron cameo so they threw together that story and crammed it into the already crowded plot line. Interesting though that he had a House moment but since so little time was devoted for that there wasn’t much to appreciate.
A lot of writing so far and I’ve not even gotten to the medical issues!
The whole men vs. women thing was stupid. Again, another sub plot crammed into the schedule. We’re left feeling that all the male doctors who were most of the almost-heroes in the last episode woke up the next day and had forgotten how to do proper tests! Seems like the writers just wanted to introduce sexual tension (why?).
Maybe if they had some nurses, somebody would have noticed the threadworms patient’s fever was not declining after the (missing) treatment, which I don’t even think was mentioned at all. Shouldn’t this guy have been burning up with such a widespread infection?
The cancer diagnosis was a bit of a jump and fortunately they got the “clear fluid” issue correct this time and prevented unnecessary radical surgery. To be honest I don’t even remember the details that let up to that because of the jumble of other things that were going on at the same time.
Also the tilt table test was wrong, wrong, wrong, completely and utterly wrong. Why would somebody be jolted around at such speeds and such an angle? First of all it would kill the machine eventually and the patient would probably break free of the table and suffer even more injuries. Ugh.
There’s probably more I am forgetting about but to be honest it’s hard to keep everything in this episode straight. The writers need to put down the caffeine and focus on telling the story instead of throwing everything they can think of at the audience. Also this plot of the new docs is getting old real fast and there needs to be resolution to it in the next episode.
BTW, you get a week off due to baseball playoffs. ;-)
October 10th, 2007 at 2:14 am
BuddWing, electrical outlets are capable of providing very high amperage, but its the body’s internal resistance which limits that. V = ir, so assuming that there is close to no resistance on the output side(it should be minimal), doubling the voltage has the effect of doubling the current.
October 10th, 2007 at 2:32 am
True BuddWing, amps are the main killer. I think on mythbusters they showed that 60 milliamps across your chest was enough to stop the heart. However, voltage is related to ampage in that higher voltage means higher electrical potential and will give out higher current as long as the resistance is the same.
As for whether sticking only one metal object into a socket will shock you, you will get electrocuted if your barefoot or standing in water or something else that conducts electricity. But most people wear shoes with rubber bottoms which dramatically increases the resistance. Still if your body is the only path that electricity can take in order to get to the earth, itll take it, so dont stick anything into electrical sockets.
October 10th, 2007 at 3:00 am
I’m beginning to wish for the old guy and number 13 (+ x) for House’s team. Amber is too much like House on one hand, and yet not interesting/funny/multi-dimensional a character on the other. The potential conflicts between the mormon and House (as shown last episode if I remember correctly) are way too uninsteresting IMO… just way too easy to mock him for his beliefs for this conflict to lead to good, funny “House-moments”. The other doctors are as of yet also quite uninteresting.
IMO the old guy and number 13 have the most potential for making a fine addition to the show.
I also thought that the scenes with Foreman were a little boring - too predictable: The way he does the diagnosis House’s way - but encourages his team, pats them on the back and apologizes for any “harsh” words… that was just laying it on a bit thick that he wants to be as good as House, but not become House as a person. They could have done that way more subtle.
Anyways, I really liked the “Hi! Greg House” during the discussion with Wilson… a gem!
But when House started to doubt his rational conviction that there is no afterlife, and then House’s cryptic silence in the scene where he wakes up and Wilson asks him “what have you seen?” and all that stuff…. that honestly made me cry out loud “Please don’t get spiritual with me now!… not “House”!!!” - and I am still a little concerned that they might, but I was quite relieved when at the end he said “told you so” - I hope they don’t go down that road again.
October 10th, 2007 at 4:05 am
This marks the second return of the “tilt table test,” something I’m keenly familiar with after being diagnosed with vasodepressor syncope. When thinking of something called a “tilt table,” I rather imagined a contraption much like the one depicted in the show: a table that swings you up and down very rapidly. Instead, the actual tilt table test is much more mundane and far less photogenic. All that happens in a real tilt table test is that they strap you to a table and elevate it so that you are suspended in the air, roughly twenty degrees off-vertical.
And then they just leave you hanging there for 45 minutes.
This sounds completely pointless, but it produced remarkable and unexpected results in me that still shock me to this day. My condition is that I faint and my heart rate nearly drops to zero after periods of strenuous activity that push my heart rate beyond about 180bpm. A stress test had me on the floor with nurses howling for a crash cart almost immediately after reaching that mark. And yet amazingly, after twenty minutes of hanging at this peculiar angle, I fainted. Apparently the test is designed to measure how effectively your body manages to push blood through your body at an…uncooperative angle, and prevents you from doing your own maintenance like sitting down, shifting your weight from foot to foot, walking, etc.
October 10th, 2007 at 4:14 am
When the patient is given the Ivermectin pills, the dangling team immediately comes in and distracts him. They don’t give him a chance to take the medicine and they carry him into the bathroom, leaving the medicine on the table. It is plausible that, given all of the tests that they are performing on him, he simply forgot about the pills. The dog may have just jumped up on the bed and grabbed the pills from the table. Some dogs will do that. It isn’t terribly implausible that someone would simply trust his doctors and forget about minor details like which pills he did or did not take.
Most kids have experimented with sticking things into slots at one time or another, including electrical outlet slots. When I was a kid I just stuck my fingernail into one to see what would happen. I just recieved a mild jolt.
October 10th, 2007 at 4:46 am
Isn’t it a little odd how they haven’t reedited the video montage that plays under the credits and theme music? It still shows House marching around with the original three in his wake. Personally, I am starting to like some of the new young ones, as their personalities get a bit of focus. The twins had more of a role this time. Amber was less cutthroat (despite the initial attempt to fake her team members out again) and showed a bit more of how she can think medically. 13 is obviously going to stick, and her intensity and focus are going to be welcome.
October 10th, 2007 at 4:50 am
In hospitals, a nurse will give the medication prescribed by a doctor.(Its a task that cannot be delegated to someone else.) If its a pill that would be taken orally, generally she/he will have water or some liquid to give the patient too. The nurse will watch the patient take the med to make sure its swallowed. Its documented in the MAR also. I think it was one of those cases where the hirelings were doing the job of the nurse/staff.
October 10th, 2007 at 5:27 am
I’ll leave the medicine to Scott, but the scenes involving electricity were ridiculous. While you only need one electrode (your body is almost always a good enough ground) a shock from one hand isn’t that severe and is unlikely to stop your heart or even knock you out. A visible wound to the hand is unlikely. Additionally, your reflexes would probably make you let go of the knife almost instantly. Yes, I’m speaking from personal experience here both as a stupid child and as an electronics hobbyist.
This is why just about everyone has a childhood “finger in the outlet” story and most of us are fine. Electrocution is much more dangerous if the current flows across the heart, as it would if you touched a live wire with one arm and a ground with the other. This is why TV technicians and electricians have a “one hand rule”.
On another note, I have to give the writers props for making me wish House could choose more than three people. I’ve started to like Amber, Kumar is great, and I like the Mormon, the Old Guy, and #13 too. I hope they don’t bring Foreman back to the team because that would mean he can only keep two of the new characters…
October 10th, 2007 at 5:42 am
Scott, I love your reviews! Read them every week after watching the episode. The way 13 ended up making a mistake that almost cost her the job felt in many ways parallel to the mistake Foreman did. House was willing to let both of them keep the jobs, because he believed that it would make them better doctors. Alas (or perhaps, Deus Ex!), Foreman’s new ex-employer didn’t think so.
On the electricity incidents were, admittedly, fun to watch. You could see House being curious about it right away and wonder how he would act on it hehe. Yes, the electric discharge comes form the body grounding the outlet, which is why you only need to put an item in one of the sockets to get electrocuted.
Most of the damage from electrocution comes from the current. Electricity behaves in the manner of Power (Watts) = Voltage (Volts) x Current (Amps). Higher voltages permit the transmission of similar power for lower currents, which is more efficient (ergo the very high voltage power lines). A human being would PROBABLY take more damage from a 110V outlet than a 220V one… but lets leave that one to theory yes? ;)
October 10th, 2007 at 5:53 am
Here is what I think happened with the dog:
Maybe the guy fell asleep, then the dog ate the pills after the doctor got the water for him?
That might makea little bit of sense
October 10th, 2007 at 6:51 am
The outlets in the episode are NEMA 15, standard, grounded outlets. They can draw 15 A, and you only need about 8-15 mA to *probably* kill you, about 75+ mA to be sure. You DO need an “exit point” for the electricity, so you HAVE to be grounded to fry properly (otherwise, where is the current going to go?). Plus outlet electricity is AC, so instead of just falling on the floor nicely, your muscles tense up and release rapidly which causes you to “freeze” and makes the situation quick a bit more difficult since now, anyone trying to save you gets zapped, AND you’re stuck to the wall getting electrocuted without any way to stop. This does, however, depend on your body’s resistance. If you are lucky, you’re lean enough and the path to ground is long enough to make you a hefty chunk of beef, which might limit the current enough to prevent muscle freeze (which happens at about 15 mA). In that case, you’ll probably just be sore, but you’ll notice TWO big, red, ugly welts — one on your hand, and the other probably on your foot somewhere (the exit point).
Paul: What are you talking about? Your body is a big, wet resistor - More voltage means more current means more DEATH.
October 10th, 2007 at 8:05 am
I’d like to believe that an MD who stuck a knife in a wall socket would at least be prevented from seeing patients, if not put on Suicide Watch in restraints.
I did enjoy Chase telling House to get bent, however.
I repeat: referring to an MD as the ‘Fat Twin’, references to genitalia, calling an employee a ‘Bitch’…now that 9/10 of the women have been fired, will the lawsuits start?
October 10th, 2007 at 9:07 am
I have a friend who is blind, and he has a guide dog. That dog will eat ANYTHING he can get his mouth on, or at least give it a few good chews — whether it’s socks, personal checks, banana peels, empty paper cups. He has a weird penchant for eating paper towels and other paper products he finds on the ground, so it’s perfectly believable that a “well-behaved” and “trained” guide dog will still be naughty and eat the pills.
October 10th, 2007 at 9:33 am
I think the foreman part was to show him getting booted from Mercy…
I think he’ll come back, get his own team, likely three house doesn’t get. Ergo, if House can have 3 docs and a sec..er.assistant, no one else will be fired at this point.
October 10th, 2007 at 9:41 am
Some physics notes. Paul, yes, the power is the product of voltage times current, but, as noted already by others, the current is determined by Ohm’s Law to be the voltage divided by the resistance. Higher voltage means higher current, which means more power.
To >:C, the thickness of the body should have negligible effect. Yes, the total current drawn will depend on the cross-sectional area of the person/wire, but I imagine muscle freeze depends on the local current. Spreading the same current over a larger area would be less harmful than constricting it to a small area. For instance if muscle freeze occurs at 15 mA, you should be able to draw around double that along your arms as half could take the biceps, half the triceps. Well, less than double to be safe. What’s the area the 15 mA needs to go through? Obviously 15 mA across your thigh would be less damaging the 15 mA along it, or even worse 15 mA along a finger muscle.
You might luck out if you are muscular enough to quickly draw enough current across your body as a whole to throw the breaker, without being enough at any one part to cause muscle freeze, but I really doubt that’s likely for the range of human body sizes.
October 10th, 2007 at 9:52 am
Wow, I always wondered why those two looked the same….
This was a good episode at a glance, but if you really look at it it seems like a lot of big stretches were made. Also, did anyone notice the increasing amounts of political remarks being made by House? I don’t know if it adds to the humor, or just annoys me. BTW, I hate Amber. She is so amazingly annoying. If I had just tried to electrocuted myself and the first thing I saw was her, I think I’d go back and give it another chance. (jk) Also, 13 drives me crazy, too. The only woman that didn’t bother me was the vet. She was cool. I like all the guys except the weird “doctors w/out borders” guy. He never says anything, does he? Yeah, and the thing about the pills on the floor made no sense to me, too. Did 13 think she knocked them on the floor? Poor Foreman, but I think he deserved it. I nearly barfed when he was like, “Good job, guys.”
October 10th, 2007 at 10:30 am
Alright, I thought the episode was Okay at best. I think that both House and the 97 second guy would both have to undergo SOME sort of psychiatric evaluation for the suicide attempt(s).
One point that my wife threw her hands up at (and I didn’t see listed yet (although I did just skim some of the longer and later posts)) She is a COTA/L (Certified Occupational Therapist Assistant), she was outraged at the newbies just picking up he patient to move him to the restroom. There were no GAIT belts, wheel chairs, or anything. You can’t just muscle a patient to another room. She said that they would have just used a bedpan.
October 10th, 2007 at 11:05 am
Actually, I assume Amber knocked the pills over. It’s a little far-fetched, but they need to weedle the applicants away, this would be a good reason to fire her, and she is incredibly unethical, although I must admit I’m not certain she’d go that for.
As for why the patient wouldn’t notice the pills were gone in this theory, well, he’s being tested for everything and the doctors are practically harrassing, I could see how he would get confused.
October 10th, 2007 at 11:52 am
I have never posted here before but I really appreciate these discussions. The Fox blurb alerted me to the idea that the patient would go untreated, and I watched the scene in which 13 administered the pills very carefully, because I could see an opportunity for a mistake. 13 put the pills on the swinging table in front of the patient. He asked for water. When she went to get a glass of water, the men came in. They asked her what she was giving him, and she wouldn’t tell them. They swarmed over him, clipping his hair, asking about stool samples, poking and prodding. She basically sort of reached out the glass of water and put it on the table, and then ducked out before they asked her anything else. After a moment one of the men pushed the table hard over against the wall. Then the patient was carried off to the bathroom. He was like a big rag doll.
This was ambiguous. The patient could have remembered to take the pills afterward. We were not shown the pills falling to the floor, either. Clearly, however, they did fall to the floor and the dog ate them or ingested a fatal dose by chewing on the cup. Clearly also the patient did not take the pills. What with the fuss the men were making, it would be hard to remember what was going on just then–the patient could have forgotten all about the pills, or remember her giving them to him but assume he had taken them. At this point he was certainly not suicidal and not likely to want to kill his dog, either. The pills were out of sight and therefore out of mind.
The moral was that it happened exactly as Wilson and Cuddy predicted: splitting the group into competitive teams, trying to hide their own solutions and discover/discredit the solutions of the other team, killed the patient.
October 10th, 2007 at 1:16 pm
Re the knife in the socket, I think the producers intentionally showed a technique that doesn’t work well, in order to prevent copycat behavior in the audience. I noticed the same thing in Burn Notice–the cool MacGyver tricks they use seem to be tweaked to make sure they don’t actually work.
Re the lack of change to the opening credits, I think they’re just avoiding giving away the outcome of the Apprentice storyline. Spoilers I read elsewhere indicate that something should change.
October 10th, 2007 at 2:02 pm
OK- I am a House fan and thought the first two episodes of this season seriously lacked any real medicine or drama. Last night was the first time I enjoyed the show again. Something happened last night that never happens in a House episode- the patient died!!! The medicine and drama varies- some episodes better than others. But has a patient ever died for a lack of trying (House bedridden)? I am glad to see the show picking up again- serious and debatable things in NJ!
October 10th, 2007 at 2:36 pm
Actually, I know that in an earlier season, House lost an infant due to a mystery disease, I remember him at the autopsy table unwrapping the body. Also, in the 2-parter last season, the initial patient (Druggy Cop) died just after Foreman was showing similar symptoms. I am sure that there have been other patients that died but, I can’t recall them off-hand.
October 10th, 2007 at 3:17 pm
I agree with the comments that the writers seemed to want to pack too much into this episode… I’m also scratching my head why House would want to do some experimentation with flat lining right THEN when he had a patient to consider… The scary part is, I could see him wanting to do it just so he could tell the fellow “You’re wrong”. After all, how else can he diagnose a near-death experience? Although he DID have one as mentioned in “Three Stories”, but it clearly didn’t leave him with any insight.
I’m no electrician, but it doesn’t surprise me that the technique shown (jabbing a knife into the socket) is likely not fatal. This is a case where television has to be careful not to show how REALLY to do it. It’s the same reason that Mythbusters doesn’t show how to make guncotton; to prevent copycats. Plus, in a lot of cases, dangerous materials are rather dangerous to make… boiling old dynamite to extract nitroglycerin, for example.
This isn’t the first time House has lost patients. He’s lost a few each season. I think what makes this one particular is that they diagnosed it correctly, but failed to administer the solution (whether by accident or deliberate purpose of the patient has been left, it seems, for the viewers to decide) and as a result, the patient died from a known and curable cause. The blow was softened a bit by making it clear that the patient was miserable and would, at best, only live a decade or two more anyway.
I like Thirteen, and I think she probably got the most character development in this episode of any of them. I think the reason House didn’t fire her was this kind of thing DOES happen, and the fact she didn’t immediately resign in tears means she has what it takes to live through it and learn from it. She certainly has the skills; she had the correct diagnosis straight off.
At the same time, I’m glad that they sent one very clear lesson out, that medicine is NOT a game, whatsoever. I’ve had some relatives in hospitals recently, and it was scary to realize how in the dark doctors can be sometimes, as much as you or me. House is great drama, but we’d never actually want a doctor like House treating us for real.
October 10th, 2007 at 3:52 pm
Re outlet:
On American (110VAC) electrical systems such as those used in hospitals (three-prong), there is only one true “ground”: the ground prong on the bottom of the outlet. The two slotted plugs are hot and common (not ground). Hot carries the 110, but when you measure from common to ground, you’ll often find some voltage (not necessarily 110) there, too. Short reason: how electric companies step down the high voltage (e.g., 10,000V) that is used for transmission to household voltage.
Everyone who has pointed out that voltage doesn’t kill is also right, to a point. One of the reasons that 110, or even 220, is unlikely to kill is because of the response those voltages generate in human muscular tissue. These voltages cause your body to “throw” you off, before you burn your insides to crispy wonderfulness. 10,000V does the same, although you cook much faster. By far the most dangerous range of voltages are between 400 - 500V: for one reason or another, these voltages cause you to “seize” onto whatever you’ve inadvertently touched.
While not a happy experience, shoving your penknife into a 110VAC socket is unlikely to serious injure (and, yes, burn as House’s hand was shown to be). I haven’t got any reference to show for this assertion, but most 110 related fatalities result from closing a circuit where the body’s revulsion is insufficient to escape the circuit, i.e., standing in water.
And, yes, to get shocked one must complete *a* circuit. Not necessarily hot to common, or hot to receptacle (outlet) ground, but also from hot to natural (building) ground, or even common to natural ground. So many ways to get zapped.
Oh, missed : 500 and 400
October 10th, 2007 at 3:55 pm
Hi Scott and thank you very much for your review. I misses the first 10 minutes of the show, so your review filled in the gaps. I give your review an A.
Thanks again for the well-written summary as seen from a doctor’s point of view.
October 10th, 2007 at 3:57 pm
I agree with Minky. For a while, I’ve contemplated giving up House–it’s just gotten too predictable. Every time they put someone in a machine, I know they’re going to have a heart attack or a seizure or the top of their head will fall off or whatever. Last night, they tested the guy and nothing happened! It was amazing! Sure, he did have that one time where he was choking, and there was the green blood, but I was just happy that there no heart attacks. You get inured to them after a while. And it was also great that there was one solution (what happened last week? There were like six solutions for the woman’s illnesses–whatever happened to Occam’s Razer?), and the guy actually died. That needs to happen sometimes.
Steve, when the infant died, most of the infants were saved. The infant we were most emotionally attached to lived. Likewise in the Foreman episode–the cop could die because Foreman didn’t. In both of the above, House saves someone. Here he doesn’t.
October 10th, 2007 at 3:58 pm
Regarding the GREEN blood. I’ve worked in the medical laboratory field for over 25 years now and I have never seen anyone have green blood. Once you spin down the tube so that the red cells fall to the bottom of the tube, the liquid part of the blood (called serum or plasma depending upon whether or not the tube has anticoagulant in it) on the top of the cells might vary in color from a light straw color to deep yellow to brownish or orange-tinged (from large amounts of bilirubin.) On a very rare occasion, I have seen a hint of green in the serum or plasma from contrast media. However, I have never seen green sludge like what was in that tube. I suppose for drama purposes, they wanted to show it having a vivid green color coming directly out of the arm rather than having to have spun down the blood in a centrifuge before noticing a strange tint to the serum. And I very much agree with the site owner that I doubt anyone injects contrast dye into a patient without first checking some blood tests for kidney function. The most common tests the lab receive STAT requests for because of X-ray or other imaging needing to be done are pregnancy tests for females and BUN and Creatinine tests (high results for the latter two would indicate that the kidneys were not functioning normally and would therefore not be able to clear the imaging dye). I have had technicians waiting on the phone for the instrument to finish up these tests so that I can give a verbal report before they do any injecting of the dye.
October 10th, 2007 at 5:13 pm
I love House, but I am unhappy with the recurring “House vs. God” theme. I get it! House thinks that believers are stupid, backwards, and fundamentally corrupt. As a person in the sciences who is a Christian, I have winced through quite a few of these episodes in the last three years, but recognize that the views depicted are out there. These episodes make me sad because it makes me think that someone like House would never tolerate someone like me. I say the writers should just drop any God talk.
October 10th, 2007 at 8:51 pm
Chriss wrote, “Actually, I assume Amber knocked the pills over. It’s a little far-fetched, but they need to weedle the applicants away, this would be a good reason to fire her, and she is incredibly unethical, although I must admit I’m not certain she’d go that for.”
Not at all likely. Not one bit. First, she wasn’t in the room when the pills were given. Second, she’d have little to gain and a lot to risk. If found out, she could not only get fired, but I imagine stripped of whatever medical license a doctor needs. To not be found out, the patient has to die. Or the women’s team had to be wrong. But if the women’s team was wrong, given the pills wouldn’t have been a concern in the first place.
Oh, and I remember a good number of patients dying in the first season. Even then, though, you knew what they died of. You always find that out.
October 10th, 2007 at 9:01 pm
I think House just wanted the high described by the clinic patient. A man who would fake incurable brain cancer in order to get pain killers pumped directly into his brain wouldn’t think twice about sticking a knife into an electrical socket for an endorphin high. On the other hand, given the mess they’ve made of it in the past, I’m not sure I want the writers to focus on House’s drug-seeking behaviour again.
October 10th, 2007 at 9:34 pm
Pretty much everything worth saying on electrocution in general, but just to comment - it’s not shown too clearly when in either case, but they may have had arm-to-arm grounds. In the clinic guy’s case, he looks like he grabs the table next to the outlet - perhaps it had some exposed metal (maybe someone with an HD PVR can take a closer look?) - and while House’s experiment is shown primarily off-camera or from the blonde candidate’s POV, there’s a metal cart next to the outlet, which might well also make a ground.
October 10th, 2007 at 9:58 pm
Thanks for another summary.
David has it right. We slowmoed the scene where the patient is given the medication, and yes, Kumar moved the tray to the right of the scene as there were moving the patient to the bathroom. It appears the dog ate the medicine one his own.
Quick question: Would there have been enough contrast to cause the blood to turn green? Wouldn’t the contrast have diluted in the blood?
October 10th, 2007 at 10:10 pm
The green blood threw me off. I first thought sulfhaemoglobinaemia, why would the patient have that? And thats only because of an article on Kevin MD that talked about a patient with that problem after taking large doses of imitrex. I guess they meant it to show the unprocessed dye. Not sure I buy it.
October 10th, 2007 at 10:48 pm
Is it possible that his kidney’s were working, and began to fail soon after the test? Also, you see the two guys come in and pick up the patient to carry him into the bathroom, WITHOUT him having taken the pills yet. Somehow we are led to believe that the dog got to the pills or the pills ended up on the floor. But if you watch carefully, you’d realize that this must have been accidental, and was not a suicide attempt. It highly probable if not likely that the patient would not remember having not taken the pills (if he even believed he still needed to) after coming back from having two men trying to collect fecal smears from him. I also thought Foreman’s acting was poor.
October 11th, 2007 at 1:52 am
As for stopping a heart with electricity…
The critical part is to get enough current long enough at the right time at the right place.
Enough current is around one 1/100 th of an amp… pretty small
right place…basically accross the heart
long enough…the tricky part…you want it right at the ST segment of the heart cycle.
this is where the big important part of the heart, the left ventricle, is repolarizing.
all this means is that the heart is getting ready to pump again…fairly important.
the ST segment is the normally flat part just after the big spike on an EKG…gives some good basic info if elevated or depresed.
wack it there enough and it stops. great if you need to cut into it for a bypass.
the reality of a shock from a socket is that each situation is complex.
most of the time you dont die, but you can.
October 11th, 2007 at 2:38 am
A couple of folks have asked about a summary of Scott’s grades, so since I have no life, I’ve put one together in a spreadsheet: http://astro.isi.edu/misc/HouseGrades.xls
I mentioned this in the comments to Human Error, but since that episode is a few months old, I’m repeating it here. Again, if Scott wants me to remove it, I will.
Should be updated weekly (or thereabouts) as soon as I finish watching the episode Scott’s reviewed.
October 11th, 2007 at 2:50 am
According to the news report here:
http://canada.com.dose.ca/topics/entertainment/story.html?id=3f4aba8d-9da7-4c80-a35d-40afbe8fc2ae
Kumar, Amber, and the plastic surgeon guy have all been chosen as regulars.
October 11th, 2007 at 5:06 am
In response to Kari:
I actually think most “normal” people would never be accepted by a character like House… and while I’m on the opposite end of the spectrum (atheist philosopher/scientist), I’d rather have House attack someone because of his belief (or lack thereof) in metaphysical entities (of whatever nature, deity, objective moral value, universal or whatever) than because of his looks, sexual orientation or something like that… but he does that, too… and we’ve come to accept it. In fact, we’ve come to like him for behaving so non-pc - for having controversial views.
My metaphysical (and mundane) convictions (although they are not carved in stone - I wouldn’t be a good philosopher/scientist if that were the case) are frequently receiving a full broadside from various shows, House concerning ethics, Lost concerning the existence of something “supernatural”… in this case, yours were. So what? Now that your convictions are the target, House has to become PC?
That would break character for sure… House is House BECAUSE he’s non-pc, arrogant, brilliant, cranky, an addict, a broken character, a cold rationalist… and an atheist. It’s his controversial opinions and behavior that make his character so interesting.
So I don’t think “House” should shrink away from the topic of religion just because its a taboo. Add to this that I think it shouldn’t be one; In fact I think that a good decade after Star Trek began to avoid the topic I think it’s time for some protagonist of a show to carry on the torch of rationality - even when it is someone as physically, emotionally and ethically crippled as House. The opposite (some character displaying religious belief) is after all very common and not really controversial. Of course I would prefer someone to “bear the torch of rationality” who is at least not as “ethically challanged” as House (Picard from TNG was a prime example), but it definitly fits his character…
I even think it makes the shows “statement” far less controversial, because the character of House is itself depicted as controversial and not as a role model at all (as opposed to Picard for example).
October 11th, 2007 at 7:11 am
I am pretty sure that the guy didn’t take the pills because he was interrupted by the other guys trying to perform the new test.
October 11th, 2007 at 8:31 am
Joey (and any others):
Please don’t post spoilers! Like really… why would you do that?
Thanks for the slightest bit of consideration in the future.
October 11th, 2007 at 9:30 am
Kari,
Sorry but I like the whole House/God thing. I think it’s very relevant to his Misanthropy and Narcissism. For House to be House, he really can’t believe in God. I have a feeling that this internal conflict will come to play a very integral plot device at some point soon.
October 11th, 2007 at 9:46 am
In response to Joey.
Olivia Wilde isn’t Amber. She’s doctor 13.
October 11th, 2007 at 10:36 am
This wasn’t one of my favourite episodes, but it was okay. My growing beef with the show is that Cuddy (Lisa Edelstein) is becoming a cipher, reduced to a few lines per show and some sighing and eye-rolling when House gets out of hand. It’s hard to make a woman as gorgeous as Edelstein boring, but the writers on the show are going a pretty good job of it. In seasons past, I enjoyed the challenge that Cuddy represented for House. That challenge is completely lacking this year. Oh, and if House makes one more smarmy remark about Cuddy’s cleavage, I’m gonna throw up or start snoring or something- surely someone as misanthropic as House can come up with better and more varied wisecracks.
October 11th, 2007 at 11:58 am
To Anon: It wasn’t meant as a spoiler, it was a news report from some website, who knows if it’s actually true.
To Rob: Oh yeah, got confused there.
October 11th, 2007 at 1:46 pm
After giving it some thought, I think that Anti-Cuddy (Foreman’s boss) had a point. House clearly believes that the end, i.e., saving someone’s life, justifies the means, i.e., unorthodox (some would say unethical) diagnotic and treatment methods. However, a rule utilitarian would argue that following the rules saves more lives in the long run; Foreman could just as easily have been wrong in breaking the rules and his patient would have died. Yes, his patient would have died if Foreman had followed the rules in this particular case, but a rule utilitarian is not concerned with outcomes in specific cases. I’m not saying she’s right or wrong, I’m just saying she had a point.
October 11th, 2007 at 3:21 pm
Robyn, in season 1, the homeless woman with rabies wasn’t diagnosed until it was too late, and she died.
Joey, Jesus FRICKIN Christ, I purposely avoided reading that news article because it had the courtesy to post a spoiler warning.
October 11th, 2007 at 3:48 pm
Long time lurker, first time commenter, and thanks so much for the reviews, Scott.
My problem with this episode is simple: ever since I was a kid I’ve lived around dogs. Big dogs, little dogs, guard dogs, yappy dogs like my step-mom’s Cairn terrier and thoughtful dogs like my German shepherd. And of all the weird things that I’ve seen dogs eat, I’ve never seen one try to eat pills. It’s really the other way around: getting any dog to take medicine is hard, and I’ve tried everything from stuffing antibiotics in hot-dogs to holding my husky’s mouth closed and vertical.
So that’s my beef - dogs will try to eat random things, sure, but those random things are always aromatic and interesting. I can’t see the dog jumping up and eating the pills.
Also, maybe more importantly, but I really hope that House doesn’t turn supernatural on us. The show was awesome in the first season when they were using classical rules of logic like Ockham’s razor to solve cases. Now we have the boring old trope of the miserable athiest who comes into contact with something….BEYOND!
And where is House’s vicodin?!!
October 11th, 2007 at 4:02 pm
Am I the only one who thought that the patient was opting for suicide and fed the pills to his dog instead? He did seem pretty happy to go at the end, either way I really don’t see how it was 13’s fault.
And I wasn’t surprised to see the other girls go home, we didn’t learn anything all that interesting about them. (Things aren’t looking that good for “grumpy” doc likewise) I was happy to see Plastic Surgeon do well again (he got 10 points!) as I’m pulling for him to make the team over “Big Love.” Ridiculously Old Fraud seems like a shoe-in to me still too.
Grumpy’s a goner - he’s not done anything, I think “heartless bitch” is the red herring in the bunch: so I’m thinking Old Fraud & 13 are locks, and hopefully surgeon makes 3. Though its tough to rule out Kumar and Big Love. The last spot is a toss up imo.
Though with Foreman getting fired it’s looking more and more like we’ll be resetting sometime during the season.
October 11th, 2007 at 4:24 pm
It seemed as though the patient didn’t really want to get better or care what happened to him. I thought his reaction to having ten doctors fighting over him seemed odd, when he said he wouldn’t be surprised if he got ten different diagnoses. So either he didn’t want the pills and that’s why he didn’t mention them, or maybe he just didn’t think about it. The doctor really should have noticed, but I guess with everything going on it’s possible that she wasn’t paying attention.
Robyn,
Also in season three they fried the immune system of a woman with a staph infection (”House Training”), and she died.
October 11th, 2007 at 8:10 pm
Cheryl is right, in a hospital setting it is the nurse’s responsibility to administer medications. A competent nurse watches the patient swallow all of his PO medications, then documents on the MAR. You never leave a patient alone with meds, particularly something that potent and vital.
But of course, House has no use for nurses, as we’ve seen. This show expects them to be obedient, silent underlings despite the fact that in many episodes, nursing assessments would have given them vital clues to the diagnosis, were this a real life situation. But it’s TV. I don’t expect much better.
October 11th, 2007 at 9:07 pm
I’m with the “trouble believing the dog would eat the pills” camp - my cats treat the ocasional dropped pill as a toy, not food, and a dog is even more dependent on smell. Granted, my Aunt’s late cocker spaniel liked to eat tissue paper, but I think that has slightly more smell than pills, and it’s softer.
And didn’t the guy with what turned out to be radiation sickness die? I mean, not in the episode, but it was pretty clear he was doomed.
October 11th, 2007 at 10:26 pm
Thanks for all the interesting comments. I enjoy reading what people have to say.
The new additions to the group are unlikely going to be his new team on a permanent basis. If you remember last season, the cop (David Morse), that tried to throw House in jail was around for 6 shows, then the rest of the season went back to its original setup. The point that keeps being made in these three shows we’ve seen up to this point is that House is not doing as well with these other new doctors as he did with Cameron, Chase and Foreman. Also, as someone mentioned, the credits at the beginning have not been changed. The writers are only trying to shake up the show, make it something that draws us watchers in to see what will happen. But they will not give up on a winning combination (House with the old team) for long: of course they may bring in the new ones to shake things up or to add to the group, but the Chase/Cameron/Foreman team will come back. Of course, I may be proven wrong, but do you know many shows that would purposely lose three of the four main characters all at once? Most shows follow patterns: this one is being pretty formulaic.
Didn’t anyone notice that Foreman’s choice to radiate his patient at Mercy hospital is EXACTLY what he did with the patient last season that had nothing but a staff infection from her bra strap? That decision last season was what ultimately drove Foreman away from House’s team in the first place. He did the radiation last season on a patient, and that ultimately killed her, then he does it again in this episode, but this time it saves the patient - and he gets fired for it? Pretty ironic, but also pretty telling. House didn’t fire Foreman when it happened last season, he just told him it was inevitable that doctors make mistakes and that House wasn’t going to forgive him for it because there was nothing to forgive. Foreman did not change his spots being away from House (that was his original reason for quitting - he didn’t want to become House), he did exactly the same thing. Told you it’s formulaic.
October 12th, 2007 at 12:03 am
Don’t know if its been said/noticed…
But in response to an earlier question, I think the patient did not take the pills for the threadworms because the guy’s team came in right at the moment 13 was administering him the pills and pushed his bed tray away to carry him to the bathroom. It looked like they pushed it near the direction of the window and chair where house later found the empty pill cup. In all the hustle and bustle the patient probably forgot he hadn’t taken the pills after he was returned to the bed.
October 12th, 2007 at 12:41 am
WTF! People who post spoilers are the lowest form of life. It’s disrespectful. Arguing about it is just worse. Go play in the street.
October 12th, 2007 at 5:15 pm
There are a lot of things that are wrong with this chapter, including the fact that any suicidal doctor should not be attending until he gets treatment. But what annoys me the most is the color of the blood sample looks like acrylic paint. As far as I know your blood can never be of that particular color. If you have a very rare medicine induced condition named sulfhemoglobinemia your blood can be deep dark green but is really rare and never considered in this episode. And, if I remember correctly, when you have iodinated contrast on your blood this is fluorescent green in the adequate illumination not in normal light so the assumption that the green blood = renal failure is wrong. And even if that was true they never even took in consideration that ICM per se could cause renal failure even in a patient that have previously normal renal function. (That seems the case in the present patient, because the men do a lot of random test, the logic is that they do the basic ones).
And I agreed with the idea that maybe the writers didnt want to show a really effective suicide attempt. Is not the kind of idea they want to put in the viewers. If they do something that actually work and a few copycats appear it could be really bad publicity.
October 12th, 2007 at 7:16 pm
I’m in the “forgot about the pills because of the male doctors interupting” camp. When they barge in, one of them even tells the guy he doesn’t need to take them because the women are wrong. I think. I was wrong about what House said to the recruits last week, so who knows.
As for House electrocuting himself - I like the idea posited by one poster here that he was looking for the high the patient described, but I don’t think that’s it. I think he was checking. Someone like House always wants to be right, and wants to doublecheck their results.
I think the news report linked above is probably speculation or rumor. That’s my theory, and I’m sticking to it. I have two predictions on how this shakes out:
1. Kal Penn, #13, and the old guy get the jobs
OR
2. House fires all the recruits and talks his old team into coming back.
October 12th, 2007 at 7:17 pm
Also, I never bothered to read the fine print at the bottom of this page with the disclaimers. I did today. Made me laugh.
October 13th, 2007 at 10:00 am
I’m actually thinking that his former employees have evolved to kind of a “wilson” level, although of course the dynamic between them and house won’t be the same. Equals who he can taunt with their past frailties. Yeah, Cameron, I like Chase like that too. Perhaps, we’ll see Foreman moving around from hospital to hospital around the country, finding himself, and maybe he stumbles into a situation where only cuddy is nuts enough to offer him a job. Kinda like Greg. Damn. Fun start to a season!!!
Oh yeah 13 is hawt, but you already knew that.
October 13th, 2007 at 10:10 am
Olivia Wilde!
October 13th, 2007 at 12:05 pm
If anyone’s curious about Anne Dudek who plays Amber Volakis/Evil Bitch, check out a DVD/Torrent of the UK comedy series The Book Group (two seasons originally shown on Channel 4). She’s plays a similar semi-sociopath (though perhaps she’s a little more likeable here) — and it’s a very wry and witty show.
October 13th, 2007 at 10:28 pm
Heck with the medicine– what about his guitar?
October 14th, 2007 at 2:35 am
Matt (and others): I thought the writers gave precious little reason for House to electrocute himself. If car wreck guy had somehow demonstrated some recognition of something he wouldn’t be able to know about House’s past (much as the next patient is intimated to do), then I could see House trying it out. In my opinion, he could only be compelled to do something like that in order to investigate something both objective–something that could be falsified–and that couldn’t be explained in far more prosaic terms (such as someone trying to defraud the hospital). Risking his life in order to look into a “far out” experience? Sorry…it doesn’t ring true.
October 14th, 2007 at 6:51 am
First of all, thanks for the great job. After watching an episode, I always turn here to know where they screwed it… ;-)
I believe that the guy was not willing to take the pills. His was a miserable life, and when he saw the thin thread of an acceptable existence severed, he thought that being the good time for leaving. In the end, it was clear that he did not regret dying.
October 14th, 2007 at 7:42 am
The one thing i fail to understand is how did they expect him to take his medication? At the end of the episode he could barely move his fingers and i thought has arm movements were limited.
October 14th, 2007 at 10:56 am
t-bone: At the time he was given the Ivermectin, he was in better shape and seemed as though he’d be able to give himself the tablets, although with his later esophagus issues, maybe he would have had trouble swallowing them. But they wouldn’t have known that yet.
October 14th, 2007 at 11:42 am
Again thanks for the review, Scott. I’m wondering about one thing, though: Why were the ones who got the right diagnosis fired? Looks like Amber was right: there can be no more than one woman on the final team.
October 14th, 2007 at 3:39 pm
[...] Scott wrote an interesting post today on House - Episode 3 (Season 4): â97 SecondsâHere’s a quick excerptThe medication doesn’t help and Stark dies quickly and quietly, his faithful dog by his side. When the dog is revealed to be dead a few minutes later, House realizes that Hoover took the patient’s Invermectin (which is fatal to that … [...]
October 14th, 2007 at 4:51 pm
First time here too… Great site, Scott, both for the comics corrections and House’s reviews
About the electrocution, you guys have all discussed the physics and medicine related effects of sticking the knife to the outlet. But one thing more for the discussion: there are some kinds of circuit breakers (called differential) that interrupt the circuit when the current “in” in the live contact is different from the current “out” from the neutral terminal (its purpose is to avoid “fugue” current like when we get zapped by touching on the outside of an old and defective fridge or - guess what - when babies put their fingers in the live terminal of a wall socket). In that case, the circuit would be shut off when the current started to flow through House, and the damage would be minimal, if not absent.
I guess such a hi-level hospital would have replaced the old time circuit breakers for differential ones for the sake of safety, but then again if they were concerned with security, they would not hire House anyway…
ForzaMilan, you made me think about something… If the former young guns evolved to reach Wilson’s level, could Wilson be a former team mate of House’s? After all, I think we never saw him in the classroom episode on the flashback. He could have been on House’s first team and then be appointed as oncologist for his achievements in the diagnosys team, which was dissolved, making House need his second team, Chase-Cameron-Foreman.
October 15th, 2007 at 3:00 am
I didnt really like the “Near-Dear-Experience”-Part, especially because House had (as Wilson pointed out) 2 neard Death experieces already. Why hasnt he mentioned them in his first discussion with Wilson? He even had visions in both of them.
What really scared me though is the trailer for the next episode. I realy, realy hope there will be a plausible solution for the “Ghosts”. I dont want X-File-House (I am an X-File-Fan, but it doesnt fit to house)
October 15th, 2007 at 7:32 pm
My dog eats pills. She once chewed open a bottle of Evening Primrose and ate enough to give herself the runs. And this dog was named Hoover. And even if he didn’t want to eat the pills (I don’t know how nasty ivermectin is), he could have ingested some just by chewing on the cup.
October 16th, 2007 at 11:48 am
Peer (regarding “Guardian Angels”): Yeah, me too. However, it’s not as though there aren’t ways out of this for the writers. For example, hallucination/dream for House, possibly related to his electrocution. Another possibility is that the patient is an ID thief. Yet another possibility is a ruse by someone on the staff–perhaps House himself, perhaps someone trying to rein him in. (To me, the title of the episode suggests this last one may be most likely; there’s very often a double meaning to the title.) In “The Right Stuff,” they fortunately went the rational route–the only actual hallucination was of Foreman, when House had just finished off a few drinks, as I recall. For the moment, I have faith in the writing staff not to get all supernatural on us.
October 16th, 2007 at 8:11 pm
Honestly, what really bothered me about this episode was the fact that the dog would eat the pills. Service dogs are trained to NOT eat things from the floor. My dog is just a therapy dog (a huge step down from a service dog) and he won’t even eat things unless I give him express permission to do so. I know this is sort of a stupid thing to be iffy about, but it really ruined the episode for me.
October 16th, 2007 at 10:03 pm
I’ve been a nurse for thirty years (ok, you didn’t see that :->) but the only time I’ve ever seen blood this colour was on Star Trek. Both my husband and I shouted out: “He’s a Vulcan!”
Other than that I thought it was a decent episode. I don’t know about service dogs, but I guess there are some that are better trained than others. My dog had to go to the emergency vet three times for eating pills - yeah, I know, our fault, but he has an uncanny talent of sniffing them out. I liked the human interaction and we had lots of fun trying to figure out who would stay on the team. Looking forward to tonight!
October 17th, 2007 at 7:24 am
Hi- This is perhaps not the right forum for this question, but you all seem to be detail people, so maybe you can help me out, as I have not been able to find this info elsewhere…Can anyone tell me the artist (female vocalist) and the title of the song that was playing when House “juiced” himself? Thanks!!
And which female is staying on the show - #13, or the Cut-Throat Bitch?
October 17th, 2007 at 3:23 pm
Lou: I don’t remember the sequence precisely, but I do remember Alanis Morissette singing “Not as We” at some point during the episode. And it’s considered gauche to post spoilers, but perhaps it will be acceptable to suggest that you apply Caesar cipher +3 and unscramble the following: BBBEFJKKOOQQRY survives, but EEFLOQQQQRXYZZ does not.
October 17th, 2007 at 5:31 pm
So House is supposed to train these doctors, correct? I feel kind of bad for Foreman because he is the one who House has had most of an impact on, and it’s screwing up his career. Isn’t House supposed to train these doctors to be successful? Sure, House is successful, but only because of his relationship with Cuddy… but it shows that it only works when you can manipulate your boss, something I doubt any of his trainees will be able to do.
I also hope they don’t make it a habit of trying to stretch out the episodes focusing on all of the past doctors like Foreman and the rest of the crew. It definitely makes everything seem crammed in there when trying to focus on two different sets of doctors.
October 18th, 2007 at 9:35 pm
Let me just correct one very common myth, since it has been repeated above a number of times. The nominal supply voltage in the USA is 120 V, not 110 V. Check the standards, or measure it yourself (if you know what you are doing). Yes it will vary up and down a bit according to circumstances, but 120 V is what the utility company tries to maintain it at.
It may make no difference to the practical likelihood of electrocution from a power outlet, but so many people seem to think it is 110 V and I have no idea why.
October 19th, 2007 at 2:35 am
As for the electrocuting, maybe they shrank from televising a too “surefire” way to electrocute yourself like stuffing metal objects into BOTH outlets of the socket simultaneously, in order to lessen the chance of any lawsuits. Aside from that, the one-handed wall stabbing sure made for greater visuals, so you could just attribute it to artistic licence.
October 20th, 2007 at 3:27 am
My theory for the pills - as the men but in on 13 giving Stark meds, they moved the table (to which you could still see the small pill cup, after everyone left, the dog (in search for food by chance, or just needed some water - the same water on the very same table with the pills) goes over and finds them - thus eating the pills.
As for the Strongyloides led to fainting part - 13 says that as soon as they cut into the lungs, they could see the worms - so it must’ve been a severe case in deed, taking in account that postmortem autopsy don’t include microscopic examinations (being that Strongyloides are only about 2.5 mm-long.)
October 23rd, 2007 at 1:06 am
Kari,
Given how religious the US is, and how trumpeted it is in media and politics of late, House wouldn’t be House if he wasn’t the cold, rational and counter-cultural thinker he is. Since having religious belief has become synonymous with being “good” then House wouldn’t be the maverick he is if he relied on god for his morality and judgment.
November 8th, 2007 at 7:43 am
Concerning Houses self-electrocution, as you said, he needs to be “grounded” and the word already contains the answer. Depending on the shoes you wear you can be permanently grounded, so yes touching one hole of the socket can be sufficient to get an electricshock. Another possibility is that you touch any other grounded metal piece with the knife or any part of your body, however non isolating shoes should be more harmful since the current has to travel through the entire body and damages more than just the hand.
November 9th, 2007 at 2:39 pm
Brian Tung: Im so glad you were right :-)
November 26th, 2007 at 6:05 pm
So misanthropy and narcicism are somehow equated with atheism? Wow. That must be because of all the child-raping atheist priests. Oh, wait…those were Christians. Well, maybe it’s the atheist terrorists who destroyed the Twin Towers and killed about 3,000 people then. Oh, wait…Muslims. Devout believers all. Or maybe it’s the many primping, greedy Chaucerian mountebanks on TV, pimping prosperity and hawking easy answers. You know, I think they might be religious as well. The emptiest people I know are theists–the most lively, atheists. I know kind people in both camps. I am fortunate to know no narcicists. Your statement equating atheism with misanthropy and narcicism is bigoted and ignorant.
December 14th, 2007 at 7:31 am
At the beginning of the episode, Stark was getting out of the back of a van. How did he get there? Who was driving, the dog? Or did he have a driver? It seems unlikely that Stark would be able to drive, what with being completely immobile. And even if he was, how and why did he get into the back of the van?
December 18th, 2007 at 4:06 pm
Okay-
I’m a veterinarian with 15 years experience. I may not be a “real doctor”, but I usually pick up on all the medical inconsistencies. My biggest gripe with this episode (and episodic TV in general) is that they NEVER get the veterinary stuff even close. Yes ivermectin is toxic, sometimes even at relatively low doses to specific breeds - primarily collies, border collies, etc. However, the signs of toxicity are obvious and dramatic. I have no problem with the dog eating the pill, you would not believe the things that I personally have removed from dog and cat gastrointestinal tracts. As an exapmle I had a larger dog eat $13.67 in change (quarters, nickels, dimes, pennies). He just gobbled up the change and no it was not coated with steak sauce. What I do have a problem with is a dog dying of ivermectin toxicity and quietly and peacefully drifting off to death. First the dog would have vomiting and diarrhea then tremors progressing to full blown seizures before finally dying from the toxicity. And correct me if I’m wrong, but one of the applicants was a veterinarian?! Come on!! If they are going to go to the trouble of having a character be a former vet, at least research the correct medical signs/symptoms etc to make it believable.
February 13th, 2008 at 9:24 pm
Hi, I’m an electrical engineer student, and about the electric shock i have to say that it is NOT NEEDED BOTH TERMINALS OF THE SOCKET TO BE TOUCHED, and as you pointed, even if the hospital is correctly grounded - in fact, this make it easier to for you to take a severe shock, since you have a complete circuit that comes from LIVE wire, through your body, and ends up completing the circuit on the grounding.
The only things i have to point as “doubt factors” are that is most likely that you only feel a strong but not almost fatal shock - there is the isolation the shoes provide you, hospital sockets usually don’t go further than 220VAC to produce significant electric current, there’s the probability that you don’t “choose” the “correct” socket terminal (eg, if you dont touch the LIVE wire, but the NEUTRAL, which is at the same potential of grounding) and there’s also the GREAT probability that the electric current doesn’t hit the heart on it’s path through the body (the most likely case of fatal electrocusion is heart failure due to currents up to 1mA or more in frequencies that are around the heart’s natural harmonic mode - like 60 or 50 hertz we see in mains wiring). For the current to reach such value, it has to be a “perfect” electric shock: high voltage, bad path through the body (heart in the way) and a nice completed circuit.
Hope that this brigthens the subject!
March 15th, 2008 at 7:35 am
I think the time between 13’s giving the pills and the dog dying can be explained by assuming the dog didn’t take them right away. They fell on the ground, rolled over etc. and then the dog found them and messed around.
April 7th, 2008 at 2:27 am
In a modern US hospital, all sockets are protected with Ground Fault Current Interrupters. These GFCI’s (US terminology) sense when the current is going out, but not coming back. This is what must happen if you touch only one conductor in the socket. When that happens the circuit breaker trips. The chance of a major cardiac event is near zero.
Besides, if House wanted to kill himself, he surely had better means at his disposal.
September 6th, 2008 at 6:36 pm
I’m a vet student and I was also really excited to see the veterinary doctor on this. I just started watching the first disc of season 4, so I hope she stays on as long as possible as she seemed to be one of the few that weren’t horribly irritating. Agree 100% with aggievet on the ivermectin toxicity in dogs. That was sloppy. Service/assistance dogs are also taught to refuse food that falls and that sort of thing. I wonder if Stark gave them to the dog, though having that particular, most people are aware that you have to give collies and other herding breeds with the MDR1 gene an alternate to Heartgard and other ivermectin based products. If he did it on purpose, he killed his dog and himself. It was cool to see an English shepherd. Not very common in the States.
September 11th, 2008 at 10:10 am
Getting electrocuted by sticking something into the socket is not the best idea, but certainly viable.
There are some errors in this house episode from the electricians view:
First in a hospital it is quite possible, that the sockets are protected with ground fault circuit interrupters (GFCI). They are devices, that sense if there is an imbalance in the current flowing in and out of a circuit. Normally electrical devices are connected between live and earth, thus the same current flows in both conductors. however, if someone touches the wires, part of the current will flow to ground (which is not the same as the neutral!). The GFCI will sense this, and interrupt the circuit. It does it very quickly, and they usually sense as little as 30mA imbalance, so the usual outcome is harmless (but nonetheless quite discomforting electric shock).
To trick the GFCI into not working, you have to behave as a normal power consuming device, that is be isolated from ground and touch live and neutral with both hands!
While burning is possible, you won’t have arcing with 110 or 230 VAC, unless the knife touches an other conductor. The current flowing trough the resistance human body is to small (but certainly lethal) for arcing. Use higher voltage (eg. electric train power) for arcing and burning from the inside of your body.
October 23rd, 2008 at 12:43 pm
Another vet student - just wanted to add to aggievet & Maren’s comments about ivermectin toxicity in collie-type dogs:
WHY does House know about this in such detail? Seriously! It was established in an older episode that he doesn’t even like dogs. The dog eating the pills was on shaky enough ground before, but if you wanted to keep some credibility in the scene, maybe have the former vet knowing more about the wormer than “we don’t give it to collies” - I have yet to meet a vet who doesn’t know *why* this isn’t given.
I suppose there is an unbreakable tradition that the medical mystery should always be wrapped up with House telling us what happened…
November 16th, 2008 at 2:37 pm
Here’s why the circuit can be completed with just one hole in the socket.
In a DC circuit, there are two terminals, and current flows from one to the other because there’s a voltage differential between them. Usually one side is at ground level, and the other side is raised. So on a DC circuit, if it is broken, can still be dangerous: if you touch a wire that differs from the (literal) ground, then you complete a circuit with the (literal) ground (which as someone pointed out is different than the electrician’s ground).
AC circuits on the other hand flip-flop (at 60 HZ in the US where House takes place), so both sides are always dangerous, and you can complete the circuit with the literal ground each time your side is flip-flopped to differ from ground. In other words the wires flip-flop as to which is live.
December 8th, 2008 at 8:46 pm
Besides everything else being said here already, I find it hugely irresponsible if not outright insane that House would endanger himself while he’s working a patient. He might not “like” patients, but now were to just blithely accept he has NO regard for their ultimate safety and feels NO responsibility whatsoever?? I fail to see how a person like that would retain their medical license. Would a ridiculous stunt like that not be noted in his permanent file and thus jeopardize any future employement outside of Princeton Plainsboro?? Or is he just planning on working there until he dies??? Also, if the man is such a wild-eyed genius, wouldnt he know that sticking a finger or a knife in the socket would do little damage?? It seems to me that with his kind of intellect, the basics of electrical theory would not escape him. Of course we saw 97 second guy do that little artistic license bit with that too, so of course they kept to the lie for the whole episode. I dont mind a little dramatic license (I know its fiction, after all), but the whole House-almost-killing-himself-in-a-way-that-really-would-never-even-come-close was just so implausible on so many levels.
And I dont believe they couldnt have gotten away with showing how it was “really” done. I think holding a television show responsible for what unstable people do after they watch is way more than a stretch. A lot of people see true to life things on TV every day. Everyone knows if you point a loaded gun and sometime, and pull the trigger, that person is rather likely to sustain injury. Yet we see shootings, murders, and other unpleasant things on TV all the time. SANE people know “not to try this at home”. And they have the general viewer discretion warning in the beginning to cover their general basis as far as sensational content.
I think what is far MORE likely, is that if the producers wanted to, they could have shown as many completely realisitic acts that were either likely or guaranteed to result in death; but they they simply chose not to.
Again, I believe its simply the creators of the show more or less either being too busy or too lazy to care, and/or taking the majority of the viewership to be mentally lazy and/or ignorant. And thats really starting to bug me about this show. Not everyone who watches this show is a 15 yearold fangirl who only watches for the soap opera.
Its getting harder and harder for me to watch the show and be entertained. I get tired of insane leaps of logic all the time. I really thought the show could be smarter and tighter than that it has been, but its fifth season now and they certainly havent gotten any better. To any viewer with any experience in any number of medical fields at all, or simply anyone with an inquisitive mind, all these giant loopholes are getting harder if not impossible to tolerate.
June 1st, 2009 at 7:47 am
“If it’s the former, why wouldn’t Stark tell someone that he didn’t get his medication?” -
Stark wanted to die! And he didn’t want the dog to be left behind without him, perhaps to be abandoned or taken to the ASPCA.
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